Allan Garland, M.D., of the Division of Pulmonary and Critical Care Medicine at MetroHealth Medical Center in Cleveland, and three associates studied costs ordered by nine intensivists in a single medical intensive care unit (ICU), who provided care to 1,184 patients during 14-day rotating shifts over a 29-month period. Average daily discretionary costs varied by 43 percent or $1,003 per admission between the intensivists who spent the most and those who spent the least.

“In this single ICU, we demonstrated large differences in resource use that are attributable to differences in physicians’ practice styles,” said Dr. Garland. “Higher-spending intensivists did not generate better outcomes than their lower spending colleagues, so it may be possible to reduce ICU costs without worsening outcomes by altering these practice styles.”

In addition to accumulating higher total discretionary costs in the ICU, the highest-spending physicians spent more on pharmacy, radiology, laboratory, blood banking and echocardiography. During the study, the respiratory system was the organ system most frequently associated with ICU admission, comprising 27 percent of the patients. Seventy-five percent of those in the ICU were transferred from the hospital’s emergency department.

Contrary to the researchers’ early expectations, survey data showed that intensivists had an accurate sense of the ICU costs they generated. The authors acknowledged that the study’s major limitation is that it evaluated only one ICU. While this may raise “concern about the generalizability of [the] results,” Drs. Garland and colleagues noted that the nature, organization, operation, staffing and case mix in their ICU was similar to others in large academic medical centers.